ICD-10 And Internal Medicine - ICD-10, Webinars, CEUs .
ICD-10 and Internal MedicineSteven M. Verno,CMBSI, CEMCS, CMSCS, CPM-MCSPage 1 of 26
ICD-10 and Internal MedicineSteven M. Verno, CMBSI, CEMCS, CMSCS, CPM-MCSNote: ICD-9-CM and ICD-10 are owned and copyrighted by the World HealthOrganization. The codes in this guide were obtained from the US Department of Healthand Human Services, NCHS website. This guide does not contain ANY legal advice. This guide shows what specific codes will change to when ICD-9-CM becomesICD-10-CM. This guide does NOT discuss ICD-10-PCS. This guide does NOT replace ICD-10-CM coding manuals. This guide simply shows a practice what ICD-10-CM will look like within theirspecialty. The intent is to show that ICD-10 is not scary and it is not complicated. This guide is NOT the final answer to coding issues experienced in a medicalpractice. This guide does NOT replace proper coding training required by a medical coderand a medical practice. Images or graphics were obtained from free public domain internet websites andmay hold copyright privileges by the owner.This guide was prepared for Free.If you paid for this, demand the return of your money! If the name of theoriginal author, Steve Verno, has been replaced, it is possible that you have athief on your hands.Page 2 of 26
For the past thirty-one (31) years, we have learned and used ICD-9-CM when diagnosiscoding for our providers. ICD stands for International Classification of Diseases. We’vebeen using the 9th Revision to code a documented medical condition. We will bereplacing the 9th Revision with the 10th revision. As someone once said, just when welearned the answers, they changed the questions. Also, for years, there has been rumorthat ICD-10 would be replacing ICD-9, and now this will soon be a reality.ICD-10 will replace ICD-9-CM as of October 1, 2014.There is a new rumor that ICD-10 will be bypassed with ICD-11.The problem with this new rumor is that there is nothing, in writing, about this rumor.The fact that ICD-10 will be effective as of October 1, 2014 is published by the Centersfor Medicare and Medicaid Services and the World Health Organization. Anytimesomeone tells you something, GET IT IN WRITING! Rumors can ruin a practice and cancost a practice a lot of money because you trust the person who told you the rumor andyou want to believe it, so you or you have your staff search the internet for anythingthat provides provenance to the rumor. In coding, there is a saying, “If it isn’tdocumented, it doesn’t exist.” If an employee or a doctor told you something, makesure that they provide you with documentation to back it up.How do I know this? My boss went to a conference and during a break, heard peopletalking about something. One of the speakers even said the same thing. When myboss came back, he had me stop my work and find out if what he heard was true.After a week of searching, I went back to my boss and told him that what he hearddidn’t exist. His reply was, “I don’t believe you.”I am a speaker at conferences. Anything I present has laws, rules, or policies providedto show that what I’m saying is true, accurate, and correct. I personally attended aconference where I heard a speaker say something that didn’t sound right. I wasn’t theonly one because many hands went up. The speaker had many respectedcertifications, yet the speaker failed to provide any proof to his statement. When Iasked for his documentation, he smiled and said I’ll send it to you. It’s been 10 yearsand I’m still waiting. All this did was lower my respect for this person and I nowquestion everything this person provides. I refuse to attend any conference where hePage 3 of 26
still speaks. My boss was correct with saying he didn’t believe me, but he learned ahard lesson. He spent about 1,000 in payroll to have me find anything that backed upwhat he heard at a conference. In the end, he dismissed what he heard and from thatpoint on, when we brought anything to him, we had to provide documented proof.That made me a better researcher.To provide proof to ICD-10 being effective on October 1, 2014, can be found x.htmlOctober 1, 2014 is on a Wednesday. What this means is, on Tuesday, September 30,2014, you will use ICD-9-CM. At the end of the day, put your ICD-9 manuals in a safeplace because you may need them later on and I will explain this. When you come inthe next morning, you will open the brand new ICD-10-CM manuals and code the visitusing them.One huge change with ICD-10-CM is that there will be more codes to select from. ICD9 has about 14,000 codes. ICD-10 starts with 68,000 codes and can go higher. ICD-9did not have a code for a cranialrectal blockage, so you couldn’t code that diagnosis oryou had to select an unspecified code, but now you can have a code for a cranialrectalblockage (YOU do know that cranialrectal blockage is not a real disease or injury). ICD10 is going to change the way YOU do business. Why? It is 100% dependent onmedical record documentation. ICD-9 was forgiving to a doctor who is lax on theirdocumentation. Steve could visit Dr. Smith with pain in his right ear. All Dr. Smith hadto document was that Steve has OM which is short for otitis media and the coder couldselect a code for simple OM.That code is 382.9 - Unspecified otitis media, Otitis media: NOS, acute NOS, chronicNOSICD-10 will require more work on the provider to document the exact type ofdiagnosis found with the patient. ICD-10 demands documentation of theanatomical area affected and allows for coding of chronic modalities.Under ICD-10-CM, you have the following codes for Otitis Media:H66.9 Otitis media, unspecifiedH66.90 Otitis media, unspecified, unspecified earPage 4 of 26
H66.91 Otitis media, unspecified. right earH66.92 Otitis media, unspecified, left earH66.93 Otitis media, unspecified, bilateralAs you can see, under ICD-9-CM, you have one code you can select if thedocumentation is not specific. The patient may have been a child with ear pain in bothears, but all the doctor wrote is “OM” and nothing more. Under ICD-10-CM, you have apossibility of five (5) codes and you do need more anatomical information to select thebest possible code.Using a pure unspecified code such as H66.9 could cause your claim to be pended orplaced under review, which could cause a significant revenue loss for the practice. Afavorite doctor I’ve known for many years is an expert witness where he is called todetermine if a malpractice lawsuit should proceed to court or if the malpracticeinsurance company should issue a check. Usually in most cases, after looking at themedical record, he just recommends writing a check. He provides instruction to medicalinterns and residents and he tells them: “Document the visit as if you had to appear incourt to defend your actions. “ I usually add, “Document the visit as if your paycheckand career is on the line.” I spend a lot of my time returning medical records foradditional information because the documentation is insufficient to code the visit with100% truth, accuracy and correctness. I code to protect the doctor, the patient, andMY paycheck. I only code what is documented. I never code a visit just to get paid.There will be an unofficial rule with coding and that rule will be: If it isn’t documented,we don’t code it. We do NOT code something just to get it paid. With 30 years ofclinical medicine in my personal background, I can say I know what should have beendone during the visit, but I cannot code based on that. I’ve seen doctors tell me, “I didthis procedure.” I say show me where it says you did this. There is no documentationto prove that the doctor said they did what they say and the doctor loses. I also NEVERcode based on what I am told on the Internet. I don’t know if what I’m told is 100%true, accurate and complete. I don’t know if the person asking the question works for adoctor or if they are a coding student and I NEVER help students. If I provide themwith answers, they submit my work as their own and I NEVER support fraud, includingacademic fraud, in any form. If I do a coders work for them, they will never learn tobecome self-sufficient.Page 5 of 26
Let’s say you have an untrained coder who needs to code a cranialrectalectomy. Theywill go to the internet and ask, “I forgot what the code is for a cranialrectalectomy, cansomeone help me?” When they don’t get a response, they become angry and thenthey will post, “Can’t anyone here help me out?” They do this hoping someone will feelguilty and give them what they want. Someone may come along with a name ofToddCPC and say we use code 99999. ToddCPC is NOT a coder. ToddCPC is a schoolkid in Omaha, Nebraska having fun punking the poster. So, now the coder enters99999 as the code and sends the claim to the insurance company. The claim is deniedpayment. Claim after claim is denied payment because this coder is sending claimswith bad codes. The doctor begins to notice the volume of denials and notices a hugedrop in his practice revenue, so he contacts a consultant. In addition, the insurancecompany put a halt on all claims sent by the doctor. They send a letter demandingmedical records and they’re now going back 20 years! The information on the claim iswrong and it is not documented in the medical record. The next letter the doctorreceives is a demand for the return of claim payments and they are demanding a 6figure refund. The doctor can’t fight this because the claim was sent with wrong codes,codes that are not supported by the medical record documentation. I recently went toa doctor who received a letter demanding the return of 64,000. That would cause himto go out of business. I showed how his coder was sending claim with wrong codesand that the medical record documentation was so poor, that they didn’t support anycorrect code that was submitted.Again, DOCUMENT THE MEDICAL RECORD AS IF YOU HAD TO GO TO COURT!Page 6 of 26
Coding GuidelinesMany of the guidelines under ICD-9-CM will not change under ICD-10-CM.You will see new guidelines because ICD-10 will offer new codes never seenbefore. As an example:ICD-9 Guideline for Symptoms:Signs and symptomsCodes that describe symptoms and signs, as opposed to diagnoses, are acceptable forreporting purposes when a related definitive diagnosis has not been established(confirmed) by the physician. Chapter 16 of ICD-9-CM, Symptoms, Signs, and Illdefined conditions (codes 780.0 -799.9) contain many, but not all codes for symptoms.7. Conditions that are an integral part of a disease processSigns and symptoms that are integral to the disease process should not be assigned asadditional codes.8. Conditions that are not an integral part of a disease processAdditional signs and symptoms that may not be associated routinely with a diseaseprocess should be coded when present.ICD-10 Guideline for Symptoms:Signs and symptomsCodes that describe symptoms and signs, as opposed to diagnoses, are acceptable forreporting purposes when a related definitive diagnosis has not been established(confirmed) by the provider. Chapter 18 of ICD-10-CM, Symptoms, Signs, and AbnormalClinical and Laboratory Findings, Not Elsewhere Classified (codes R00.0 - R99) containsmany, but not all codes for symptoms.5. Conditions that are an integral part of a disease processSigns and symptoms that are associated routinely with a disease process should not beassigned as additional codes, unless otherwise instructed by the classification.6. Conditions that are not an integral part of a disease processAdditional signs and symptoms that may not be associated routinely with a diseaseprocess should be coded when present.As you can see, both guidelines are virtually identical, so the change to ICD10 will not be a shock to a trained coder.Page 7 of 26
Coding GuidelinesThe following are some ICD-10 coding guidelines that may impact Internal Medicineproviders. Please note that these are not ALL of the ICD-10 guidelines, just a sample,and, again, these look identical to ICD-9 guidelines:Signs and symptomsCodes that describe symptoms and signs, as opposed to diagnoses, are acceptable forreporting purposes when a related definitive diagnosis has not been established(confirmed) by the provider. Chapter 18 of ICD-10-CM, Symptoms, Signs, and AbnormalClinical and Laboratory Findings, Not Elsewhere Classified (codes R00.0 - R99) containsmany, but not all codes for symptoms.Conditions that are an integral part of a disease processSigns and symptoms that are associated routinely with a disease process should not beassigned as additional codes, unless otherwise instructed by the classification.Conditions that are not an integral part of a disease processAdditional signs and symptoms that may not be associated routinely with a diseaseprocess should be coded when present.Multiple coding for a single conditionIn addition to the etiology/manifestation convention that requires two codes to fullydescribe a single condition that affects multiple body systems, there are other singleconditions that also require more than one code. “Use additional code” notes are foundin the Tabular at codes that are not part of an etiology/manifestation pair where asecondary code is useful to fully describe a condition. The sequencing rule is the sameas the etiology/manifestation pair, “use additional code” indicates that a secondary codeshould be added.For example, for bacterial infections that are not included in chapter 1, a secondarycode from category B95, Streptococcus, Staphylococcus, and Enterococcus, as thecause of diseases classified elsewhere, or B96, Other bacterial agents as the cause ofdiseases classified elsewhere, may be required to identify the bacterial organismcausing the infection. A “use additional code” note will normally be found at theinfectious disease code, indicating a need for the organism code to be added as asecondary code.“Code first” notes are also under certain codes that are not specifically manifestationcodes but may be due to an underlying cause. When there is a “code first” note and anunderlying condition is present, the underlying condition should be sequenced first.“Code, if applicable, any causal condition first”, notes indicate that this code may beassigned as a principal diagnosis when the causal condition is unknown or notPage 8 of 26
applicable. If a causal condition is known, then the code for that condition should besequenced as the principal or first-listed diagnosis.Multiple codes may be needed for late effects, complication codes and obstetric codesto more fully describe a condition. See the specific guidelines for these conditions forfurther instruction.Acute and Chronic ConditionsIf the same condition is described as both acute (subacute) and chronic, and separatesubentries exist in the Alphabetic Index at the same indentation level, code both andsequence the acute (subacute) code first.Diabetes mellitusThe diabetes mellitus codes are combination codes that include the type of DM, thebody system affected, and the complications affecting that body system. As many codeswithin a particular category as are necessary to describe all of the complications of thedisease may be used. They should be sequenced based on the reason for a particularencounter. Assign as many codes from categories E08 – E13 as needed to identify all ofthe associated conditions that the patient has.Type of diabetesThe age of a patient is not the sole determining factor, though most type 1 diabeticsdevelop the condition before reaching puberty. For this reason type 1 diabetes mellitusis also referred to as juvenile diabetes.Type of diabetes mellitus not documentedIf the type of diabetes mellitus is not documented in the medical record the default isE11.-, Type 2 diabetes mellitus.Diabetes mellitus and the use of insulinIf the documentation in a medical record does not indicate the type of diabetes butdoes indicate that the patient uses insulin, code E11, Type 2 diabetes mellitus, shouldbe assigned for type 2 patients who routinely use insulin, code Z79.4, Long-term(current) use of insulin, should also be assigned to indicate that the patient uses insulin.Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2patient’s blood sugar under control during an encounter.Secondary Diabetes MellitusCodes under category E08, Diabetes mellitus due to underlying condition, and E09,Drug or chemical induced diabetes mellitus, identify complications/manifestationsassociated with secondary diabetes mellitus. Secondary diabetes is always caused byanother condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas,pancreatectomy, adverse effect of drug, or poisoning).Page 9 of 26
Secondary diabetes mellitus and the use of insulinFor patients who routinely use insulin, code Z79.4, Long-term (current) use of insulin,should also be assigned. Code Z79.4 should not be assigned if insulin is giventemporarily to bring a patient’s blood sugar under control during an encounter.Assigning and sequencing secondary diabetes codes and its causesThe sequencing of the secondary diabetes codes in relationship to codes for the causeof the diabetes is based on the tabular instructions for categories E08 and E09. Forexample, for category E08, Diabetes mellitus due to underlying condition, code first theunderlying condition; for category E09, Drug or chemical induced diabetes mellitus,code first the drug or chemical (T36-T65).Secondary diabetes due to drugs Secondary diabetes may be caused by an adverseeffect of correctly administered medications, poisoning or late effect of poisoning.See section I.C.19.e for coding of adverse effects and poisoning, and section I.C.20 forexternal cause code reporting.Hypertension with Heart DiseaseHeart conditions classified to I50.- or I51.4-I51.9, are assigned to, a code fromcategory I11, Hypertensive heart disease, when a causal relationship is stated (due tohypertension) or implied (hypertensive). Use an additional code from category I50,Heart failure, to identify the type of heart failure in those patients with heart failure.The same heart conditions (I50.-, I51.4-I51.9) with hypertension, but without a statedcausal relationship, are coded separately. Sequence according to the circumstances ofthe admission/encounter.Hypertensive Cerebrovascular DiseaseFor hypertensive cerebrovascular disease, first assign the appropriate code fromcategories I60-I69, followed by the appropriate hypertension code.Hypertension, SecondarySecondary hypertension is due to an underlying condition. Two codes are required: oneto identify the underlying etiology and one from category I15 to identify thehypertension. Sequencing of codes is determined by the reason foradmission/encounter.Hypertension, TransientAssign code R03.0, Elevated blood pressure reading without diagnosis of hypertension,unless patient has an established diagnosis of hypertension. Assign code O13.-,Gestational [pregnancy-induced] hypertension without significant proteinuria, or O14.-,Page 10 of 26
Gestational [pregnancy-induced] hypertension with significant proteinuria, for transienthypertension of pregnancy.Hypertension, ControlledThis diagnostic statement usually refers to an existing state of hypertension undercontrol by therapy. Assign code I10.Hypertension, UncontrolledUncontrolled hypertension may refer to untreated hypertension or hypertension notresponding to current therapeutic regimen. In either case, assign code I10.Acute exacerbation of chronic obstructive bronchitis and asthmaThe codes in categories J44 and J45 distinguish between uncomplicated cases andthose in acute exacerbation. An acute exacerbation is a worsening or a decompensationof a chronic condition. An acute exacerbation is not equivalent to an infectionsuperimposed on a chronic condition, though an exacerbation may be triggered by aninfection.Acute respiratory failure as principal diagnosisCode J96.0, Acute respiratory fail
ICD-10 will replace ICD-9-CM as of October 1, 2014. There is a new rumor that ICD-10 will be bypassed with ICD-11. The problem with this new rumor is that there is nothing, in writing, about this rumor. The fact that ICD-10 will be effective as of October 1, 2014 is published by the Centers
ICD-9 724.02 ICD-10 M48.06 Spinal stenosis, lumbar region ICD-9 720.2 ICD-10 M46.1 Sacroiliitis, not elsewhere classified ICD-9 724.8 ICD-10 R29.898 Other symptoms and signs involving the ** musculoskeletal system ICD-9 721.42 ICD-10 M47.16 Other spondylosis with myelopathy, lumbar region ICD-9 723.1 ICD-10 M54.2 Cervicalgia ICD
More on ICD-10. ICD-10-PCS replaces ICD-9-CM inpatient procedure coding: ICD-9-CM procedure codes 3 to 4 numeric digits ICD-10-CM codes 7 alphanumeric digits ICD-10-PCS code format substantially different from ICD -9 Unlike ICD-9, ICD-10
ICD-10 Tips from PHCS The Road to ICD-10 Flyer AMA ICD-10 Project Plan Template Educational Tools Folder Precyse University ICD-10 Physician Office Solution Brochure Precyse Catalog of ICD-10 Courses ICD-10 Precyse Apps for Physicians Resources Folder Free Resources ICD-9 to ICD-10 Crosswalk of Most Common ICD-9 .
Dec 14, 2010 · ICD-9. ICD-10. ICD-9. ICD-10. Inactive. Active. Combined Code Set. Core Technologies. ICD-9 and ICD-10 code values are unique. Generally, the industry is taking one of two approaches as it relates to the ICD-10 transition: Remediation: Modify/expand all systems and processes to accommodate ICD-
ICD-10 to ICD-10-CM Based on FY2017 ICD-10-CM codes Category and subcategory codes are shaded in grey and marked with an Cells shaded in pink and marked with an *indicate the preferred code when a single code maps to multiple codes (see Introduction) Reportable Neoplasms . Type of Code ICD-10 Category Chapter II (Neoplasms) ICD-10 Term . ICD .
According to CMS, GEMs are “a tool to assist with the conversion of ICD-9-CM codes to ICD-10 and the conversion of ICD-10 codes back to ICD-9-CM. The GEMs are forward and backward mappings between the ICD-9-CM and ICD-10 coding systems.” Watch out: Although you’ll see the term “cr
7/13/2015 1 Tonya Mitchell, RHIT July 17, 2015 Objectives Review the History of ICD‐10 Discuss the Myths and Facts of ICD‐10 Discuss GlGeneral DttiDocumentation CtConcepts Review ICD‐10 Documentation Concepts Analyze Documentation for Top Diagnosis in ICD‐10 WHY CHANGE FROM ICD‐9 TO ICD‐10? ICD‐9 was developed in the 1970s and cannot support current
of the previous ICD-9 coding system. The volume of ICD-10 codes as compared to ICD-9 codes is significant because in ICD-10, the code size has been expanded, code values and interpretations have been redefined and specificity has been further improved. Global ICD-10 adoption The current version of ICD is ICD-10, which was adopted by the World .
